Novel mesh suture may resist bone cutting seen with wire-based sternal closures

Area of Science:

• Biomaterials Science
• Orthopedic Surgery
• Medical Device Engineering

Background:

• Sternal dehiscence, a complication of sternotomy, is often linked to wire-based closures causing bone damage and infection.
• Current sternal closure methods using wires can lead to bone cutting and sternal instability.

Purpose of the Study:

• To investigate the efficacy of a novel mesh suture in minimizing bone cutting during sternal closure.
• To compare the force distribution and bone-cutting properties of mesh sutures against traditional wire closures in sternal models.

Main Methods:

• Sternal models were closed using various materials: single sternal wires, double sternal wires, braided poly(ethylene terephthalate) sutures, single-wrapped mesh sutures, and double-wrapped mesh sutures.
• Models underwent axial loading (1020 N) and cyclic loading to simulate chest-wall forces, breathing, and coughing.
• Image analysis quantified needle hole enlargement (bone cutting) and sternal distraction.

Main Results:

• Double-wrapped mesh sutures and double sternal wires showed minimal needle hole enlargement (7.2% and 9.2%, respectively) under axial loading.
• Single wires and braided sutures exhibited significantly greater bone cutting (47.0% and 168.3% increase).
• During cyclic loading, mesh sutures demonstrated significantly less bone cutting (P=.02) than double wires, with comparable sternal separation (P=.07).

Conclusions:

• Mesh sutures offer a potential alternative to wire closures for sternal closure, effectively reducing bone cutting.
• This biomaterial may improve sternal stability and reduce complications associated with sternotomy.
• Further clinical studies are warranted to validate these findings in patient populations.